Short Term Omeprazole Use and Markers of Calcium Homeostasis
Objective: Several studies indicate a higher prevalence of fracture following long term utilization of proton pump inhibitors (PPIs), among them omeprazole is the most widely used. However, the exact mechanisms leading to this complication are largely unknown. We studied short term effects of omeprazole on some markers of calcium metabolism.
Material and Methods: In thirty young adult patients with gastroesophageal reflux, omeprazole was prescribed at 20 mg twice daily for thirty days. Baseline characteristics, as well as data after treatment with omeprazole, were compared. We also measure important parameters in sixty age and sex match healthy individuals at baseline.
Results: The mean age of patients was 31.8 year and there was no significant difference regarding age, sex, Body mass index (BMI), serum calcium, serum alkaline phosphatase and Parathyroid hormone (PTH) between cases and controls. Although, most of the patients were vitamin D deficient (mean = 29.7 nmol/l); compared to controls serum 25 OH Vitamin D was higher (P= 0.005) and serum phosphate was lower (P= 0.001) in patients. In addition, there was a significant increase in alkaline phosphatase (P=0.01) and borderline decrease in serum calcium (P= 0.057), thirty days after treatment with omeprazole.
Conclusions: High dose omeprazole after thirty days in the presence of vitamin D deficiency affects bone turnover probably by decreasing calcium absorption.
2. Heidelbaugh JJ, Goldberg KL, Inadomi JM. Overutilization of proton pump inhibitors: A review of cost-effectiveness and risk in PPI. American Journal of Gastroenterology. 2009.
3. Roux C, Briot K, Gossec L, Kolta S, Blenk T, Felsenberg D, et al. Increase in vertebral fracture risk in postmenopausal women using omeprazole. Calcif Tissue Int. 2009;
4. Khalili H, Huang ES, Jacobson BC, Camargo CA, Feskanich D, Chan AT. Use of proton pump inhibitors and risk of hip fracture in relation to dietary and lifestyle factors: A prospective cohort study. BMJ. 2012;
5. Ngamruengphong S, Leontiadis GI, Radhi S, Dentino A, Nugent K. Proton pump inhibitors and risk of fracture: A systematic review and meta-analysis of observational studies. American Journal of Gastroenterology. 2011.
6. Vestergaard P, Rejnmark L, Mosekilde L. Proton pump inhibitors, histamine H2 receptor antagonists, and other antacid medications and the risk of fracture. Calcif Tissue Int. 2006;
7. Yang YX, Lewis JD, Epstein S, Metz DC. Long-term proton pump inhibitor therapy and risk of hip fracture. J Am Med Assoc. 2006;
8. Pytlik M, Cegieła U, Nowińska B, Folwarczna J, Śliwiński L, Kaczmarczyk-Sedlak I, et al. Bone remodeling after administration of proton pump (H +/K +-ATPase) inhibitors and alendronate in ovariectomized rats. Acta Pol Pharm - Drug Res. 2012;
9. Fossmark R, Stunes AK, Petzold C, Waldum HL, Rubert M, Lian AM, et al. Decreased bone mineral density and reduced bone quality in H +/K +ATPase beta-subunit deficient mice. J Cell Biochem. 2012;
10. Mizunashi K, Furukawa Y, Katano K, Abe K. Effect of omeprazole, an inhibitor of H+, K+-ATPase, on bone resorption in humans. Calcif Tissue Int. 1993;
11. Hyun JJ, Chun HJ, Keum B, Seo YS, Kim YS, Jeen YT, et al. Effect of omeprazole on the expression of transcription factors in osteoclasts and osteoblasts. Int J Mol Med. 2010;
12. O’Connell MB, Madden DM, Murray AM, Heaney RP, Kerzner LJ. Effects of proton pump inhibitors on calcium carbonate absorption in women: A randomized crossover trial. Am J Med. 2005;
13. Graziani G, Como G, Badalamenti S, Finazzi S, Malesci A, Gallieni M, et al. Effect of gastric acid secretion on intestinal phosphate and calcium absorption in normal subjects. Nephrol Dial Transplant. 1995;
14. Graziani G, Badalamenti S, Como G, Gallieni M, Finazzi S, Angelini C, et al. Calcium and phosphate plasma levels in dialysis patients after dietary Ca-P overload: Role of gastric acid secretion. Nephron. 2002;
15. Hardy P, Sechet A, Hottelart C, Oprisiu R, Abighanem O, Said S, et al. Inhibition of gastric secretion by omeprazole and efficiency of calcium carbonate on the control of hyperphosphatemia in patients on chronic hemodialysis. Artif Organs. 1998;
16. Milman S, Epstein EJ. Proton pump inhibitor-induced hypocalcemic seizure in a patient with hypoparathyroidism. Endocr Pract. 2011;
17. Hansen KE, Jones AN, Lindstrom MJ, Davis LA, Ziegler TE, Penniston KL, et al. Do proton pump inhibitors decrease calcium absorption? J Bone Miner Res. 2010;
18. Wright MJ, Sullivan RR, Gaffney-Stomberg E, Caseria DM, O’Brien KO, Proctor DD, et al. Inhibiting gastric acid production does not affect intestinal calcium absorption in young, healthy individuals: A randomized, crossover, controlled clinical trial. J Bone Miner Res. 2010;
19. Kaykhaei MA, Hashemi M, Narouie B, Shikhzadeh A, Rashidi H, Moulaei N, et al. High prevalence of Vitamin D deficiency in Zahedan, Southeast Iran. Ann Nutr Metab. 2011;
20. Kocsis I, Arató A, Bodánszky H, Szönyi L, Szabó A, Tulassay T, et al. Short-term omeprazole treatment does not influence biochemical parameters of bone turnover in children. Calcif Tissue Int. 2002;
21. Shapses SA, Sukumar D, Schneider SH, Schlussel Y, Brolin RE, Taich L. Hormonal and dietary influences on true fractional calcium absorption in women: Role of obesity. Osteoporos Int. 2012;
22. Hultin H, Edfeldt K, Sundbom M, Hellman P. Left-shifted relation between calcium and parathyroid hormone in obesity. J Clin Endocrinol Metab. 2010;
23. Lombardo L, Foti M, Ruggia O, Chiecchio A. Increased Incidence of Small Intestinal Bacterial Overgrowth During Proton Pump Inhibitor Therapy. Clin Gastroenterol Hepatol. 2010;
24. Ruscin JM, Lee Page R, Valuck RJ. Vitamin B12 deficiency associated with histamine2-receptor antagonists and a proton-pump inhibitor. Ann Pharmacother. 2002;
25. Thongon N, Krishnamra N. Omeprazole decreases magnesium transport across Caco-2 monolayers. World J Gastroenterol. 2011;
26. Hoorn EJ, van der Hoek J, de Man RA, Kuipers EJ, Bolwerk C, Zietse R. A Case Series of Proton Pump Inhibitor-Induced Hypomagnesemia. Am J Kidney Dis. 2010;
27. Cundy T, Dissanayake A. Severe hypomagnesaemia in long-term users of proton-pump inhibitors. Clin Endocrinol (Oxf). 2008;
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